HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED U
Date: SCANNED Permit Number:
BY RECEIVED
• St. Lucie County 16 '1;q
Building Permit Application
LAPR
cie County, perm
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: Ee, S,
Legal Description:
Property Tax ID#:'A -�l7
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Lot No.VN%6
Block No.
DETAILED DESCRIPTION OF WORK: III
CONSTRUCTION INFORMATION:
HYAC GGaasTank ❑Gas Piping _Shutters Windows/Doors
Electric LJ Plumbing Sprinklers 1:1 Generator 0 Roof = Roof pitch
Total Sq. Ft of Construction✓
Cost of Construction: $ (006-
S Ft. of First Floor: _
Utilities: Sewer Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name C Z
Name:
Address:
Company:\1c�eS
C'
City pc��,� State7VL
Code:C\`=� Fax:
Phone No. \ -A
Address:
CitQ
Zip Code:��i�\yLn
Phone No. -
StatZip L
Fax: -
c�
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail. v
m (�
State or County License:
�b
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
COMPANY: Not Applicable
�'Ly• i State: - L CIO: State
Zip: 3ybq� Phone - ZIP, Phone:
FEE SIMPLE TITLE HOLDER: ^ Not Applicable BONDING COMPANY: Not Applicable
Name: OA4e-M 9 L.6A V Goo L Name:
Address: AJ
L F hr/ A/7A n r ,.7- /� , ,. �'+�� _ Acidness:
OWNER/ CONTRACTOR AFFIDVIT: Application is he
I certify that no work or installation has commenced prior
St. Lucie County makes no
which is in conflict with an
structure. Please consult
In consideration of the granting of this requested permit I dt
in accordance with the approved plans, the Florida Building C
The following building permit applications are exempt from u
accessory structures, swimming pools, fences, walls, signs, sc
WARNING TO OWNER: Your failure to Record a Notii
improvements to your property. A Notice of Comm
before the first inspection. If you intend to obtain f
commencing work or recording our Notice f C
Phone -
tbtain a permit to do the work and installation as indicated.
of a permit
yaws or nand covenants that build
dreesstrict or prohibit such
your deed for any restrictions which,may apply.
that 1 will, in all respects, perform the work
Lucie County Amendments.
full concurrency review: room additions,
and accessory uses to another non-residential use
lencement may result in your paying twice for
must be recorded and posted on the jobsite
onsult with lender or an attorney before
0 0MUMIMCMUnt.
Signature Owner/
of Le
a ntractor as Agent fo Owner "
I
1 Signature of Contractor/License Holder
i ICI
STATE OF FLORIDA
c
STATE OF FLOR A
COUNTY OF
`� ��
COUNTY OF_� �e�e
The forgoing instrument was acknowledged before me
this day of iJ6T. 2pk by
The forgoing instrument was acknowledged before me
this day of��r. 20<i by
Name of Perysh
Personally Known
making statement
OR Produced Identification
'.I Name ofperson�+akingstatement
Personally Known ✓
Type of Identification
OR Produced Identification
1'
Type of Identification
Produced
Produced
I
(Signature of Notary Public -State of Florida )'
(Signature of Notary Public- State of Florida )
Commission No.
(Seal) ) .I
'Commission No.
.,o4yr ep••., TfELCA iI HUNTER I'
::/•�1�F�
Notary Public - State of Florida
TEL
,� ion -; SPub LATER
�y Notary Public - State of Florida
Commission C GG 281062
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DATE
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DATE
COMPLETED
tev. R/2/]7
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